{
"Npi": {
"NPI": "1669886537",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "PARKE",
"FirstName": "JACOB",
"MiddleName": null,
"NamePrefix": "DR.",
"NameSuffix": null,
"Credential": "M.D.",
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": null,
"OtherFirstName": null,
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": null,
"FirstLineMailingAddress": "4515 WILES RD STE 201",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "COCONUT CREEK",
"MailingAddressStateName": "FL",
"MailingAddressPostalCode": "33073-3414",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "954-943-1133",
"MailingAddressFaxNumber": "954-783-6845",
"FirstLinePracticeLocationAddress": "4515 WILES RD STE 201",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "COCONUT CREEK",
"PracticeLocationAddressStateName": "FL",
"PracticeLocationAddressPostalCode": "33073-3414",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "954-943-1133",
"PracticeLocationAddressFaxNumber": "954-783-6845",
"EnumerationDate": "06/18/2014",
"LastUpdateDate": "03/28/2022",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": [
{
"TaxonomyCode": "208600000X",
"TaxonomyName": "Surgery Physician",
"LicenseNumber": "4301105492",
"LicenseNumberStateCode": "MI",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208800000X",
"TaxonomyName": "Urology Physician",
"LicenseNumber": "2019024767",
"LicenseNumberStateCode": "MO",
"PrimaryTaxonomySwitch": "N"
},
{
"TaxonomyCode": "208800000X",
"TaxonomyName": "Urology Physician",
"LicenseNumber": "ME154933",
"LicenseNumberStateCode": "FL",
"PrimaryTaxonomySwitch": "Y"
}
]
},
"HealthcareProviderTaxonomyGroups": null
}
}